Bradley Kent Westbrook, D.D.S
Individual provider Active NPI General Practice Dentistry · Jacksonville, TX
NPI 1043471576 · NPPES record last updated Dec 19, 2013
Key facts
- NPI
- 1043471576
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 24043 (TX)
- Practice address
- 2110 E Rusk St
Jacksonville, TX 75766-9052 - Phone
- (903) 586-0741
- Fax
- (903) 586-0649
- NPI assigned
- Jun 18, 2008
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160516000897 | TX | Order and Referring Only - Dentist |
7810286853 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 24043 | TX | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Family & Cosmetic Dentistry PC | General Practice | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 24043 | TX | Yes |
Addresses
Primary practice location
2110 E Rusk St
Jacksonville, TX 75766-9052
Mailing address
2110 E Rusk St
Jacksonville, TX 75766-9052
Phone (903) 586-0741
Other providers in Jacksonville, TX
- Andre Joseph Ward
- Austin A Weaver
- Craig C Weaver
- Kent P Webb
- Susan Carol West Jan
- Kierra Nicole Whitaker
- Kristin White
- Lucia Leigh Williams
- Ashley Newman Wilson
- Fred B Wingate
All providers in Jacksonville, TX · General Practice Dentistry in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 19, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.